Health Newsletter

new each month

Health and Fitness

(health information and your personal health)

*** a monthly newsletter ***          Vol.2, No.5, May 15, 2003

May 2003  HEALTH TOPICS:

West Nile Virus: How Dangerous Is It?

West Nile Virus (WNV) is a flavivirus. Related flaviviruses cause Dengue fever and Yellow fever. The reason WNV has been on the news is that until 1990 the virus has not been observed in North America.

Up to that point it was only known to be present in Africa, India, the Middle East, southern France, the former Soviet Union and Indonesia. But since 1999 WNV has been spotted in dead crows in New York and recently also in Toronto/Ont. It is predicted that in 2003 the virus likely will reach the western parts of Canada. It has been spotted already in Washington late in 2002. It is mainly transmitted between birds and mosquitoes. Humans only get infected with WNV through infected mosquito bites. Only about 1% of all mosquitoes are infected with the WNV in endemic areas. The incubation time is 2 to 15 days after a mosquito bite.

Symptoms:

About 80% of people who get infected with West Nile Virus are without symptoms. About 19% will develop mild flu-like symptoms with muscle aches, a fever and a headache.

There may also be a skin rash and swollen lymph glands. After a week or less the symptoms disappear and the patient has recovered. In 1% of patients the infection can be severe with a high fever, a headache and a stiff neck due to meningitis. Meningitis in this case is from an infection and inflammation of the lining of the spinal cord and brain with the WNV. In some more severe cases the virus can enter the brain tissue and cause a viral encephalitis with a high death rate. People over 50 years of age are particularly susceptible for developing the more severe forms, which often lead to death. Extreme muscle weakness and headaches are usually the presenting symptoms along with a high fever. They may turn unconscious, particularly with encephalitis, may stop breathing and may need to be intubated and put on a ventilator.

Diagnostic tests:

After clinicial suspicion the physician likely will either do a blood test or do a spinal puncture to remove a sample of spinal fluid for specific anti-WNV antibody testing.

Prevention:

The risk is very small as stated above as only 1% of mosquitoes are infected. Prevention consists in steps to prevent mosqitoes from breeding and to prevent them from stinging you. Instal screens on doors and windows.

Stay indoors at dawn, dusk and in the ealry evening. Avoid forested areas during the course of the day. Wear light colored, baggy clothes ( mosquitoes like dark clothes) with long sleeves and long pants. Your lawn should be mowed short to cut down on places for mosquitoes to hide. Still waters such as in clogged gutters, in saucers under plant pots, puddles of water under tarps or in old tires need to be eliminated. Bird feeders need to be flushed out with a garden hose every two to three days to interrupt the mosquito breeding cycle. Use a mosquito repellant with DEET in it (should not contain more than 30% for adults or 10% for children to avoid toxicity). Do not use DEET on children younger than 6 months old.

Therapy:

At the present time there is no treatment other than supportive therapy in hospital for sick patients. Remember that the main breeding cycle in nature for WNV is between birds and mosquitoes. As humans we need to watch that we stay "out of the loop" by following the above preventative measures.

Here are a few useful links regarding West Nile Virus:

Health Canada site on West Nile Virus

CDC site on West Nile Virus (question and answer style)

Center for Biological Informatics site of the US

BC Centre for disease control (Canada)

Bipolar Disorder In Children/Teens Different From Adults

Bipolar disorder used to be called "manic-depressive illness" in the past, now it is termed "bipolar disorder". It is a multifaceted mental illness where subtle changes in the mix of brain hormones can lead to periods when the patient is euphoric, manic or even psychotic (manic episode), but at other times it seems that someone "pulled the plug", so to speak, and the patient is depressed, lethargic and perhaps even suicidal.

To complicate matters even further,and this was the subject of a recent seminar at the Child and Health Resource Institute in London/Ontario, symptoms in children and teens are often completely different from symptoms in adults. This can be very misleading to the healthcare workers and the immediate family members. It can also delay the diagnosis and appropriate treatment of bipolar disorder. The Medical Post in its April 1, 2003 edition (page 54) published a review of this topic, based on a presentation by Dr. Margaret Steele at this seminar in London/Ont. Dr. Steele is a child psychiatrist of the University of Western Ontario. Here is a summary of her findings with regard to depressive symptoms in children/teens when compared to adults in tabular form.

Dr. Steele explained that bipolar disorder is relatively rare in children and adolescents. About 0.5% or less of children in pre-puberty and about 1% of adolescents are affected. But these children/adolescents usually have a family history of either bipolar disorder or depression. 20% of adults with bipolar disease experienced their first episodes of the disease during the teen years.

The other part of the equation of bipolar disorder is mania. Different names are used for this hyperactive state of the mind depending on how severe it is: 'hypomania' for the lower end, 'mania' for an abnormally elevated and expansive mood lasting for at least 1 week. The most severe form of mania is a 'manic psychosis' where the person is "completely out of it" and needs to be hospitalized. Again there are some differences of how a manic episode is expressed in children/teens when compared to adults. Dr. Steele covered this in the seminar mentioned above as well and I have summarized the findings in tabular form again as follows.

Child psychiatrists are most familiar with assessing whether a child or adolescent has bipolar disorder. Apart from symptoms being quite variable as mentioned above, there are also lower-key versions of bipolar disorder.

A milder, scaled down version of a manic episode is called 'hypomania' as explained above and when expressed in bipolar disease this can lead to 'bipolar II disorder'. In 60% of adolescents with bipolar disease a 'mixed bipolar episode' can be diagnosed. Typically, in these cases the teenager would have depressive symptoms in the morning (feeling low energy, feeling terrible etc.), but later in the day after school would get revved up having problems winding down at night. Often such behavior is very stressful for the parents, particularly as bipolar disorder is running in families and one of the parents may have established bipolar disorder that is being treated.

The reason for including this overview here is that many parents may recognize some symptoms in their offspring that warrant a closer look by a child psychiatrist. By diagnosing this condition early and treating it, these children and teens can have a normal life and prevent a lot of needless suffering and danger.

Click for links about bipolar disorder , depression and watch for suicide.

Early SARS Treatment In Hong Kong Reduces Death Rate Dramatically

Dr. Loletta Kit-Ying So from the Pamela Youde Nethersole Eastern Hospital in Hongkong reported on May 10, 2003 in the medical journal The Lancet (Lancet 2003;361:1615-1617) about their experience with early SARS treatment. Key to the success of this group is early recognition and early treatment of SARS. They found that high doses of corticosteroids to control the inflammatory reaction of the airways coupled with the antiviral antibiotic ribavirin has meant a breakthrough in the treatment of SARS. They have treated 50 patients with the new combination protocol.

Medication protocol:

Initially the patient is started on the fluoroquinolone antibiotic levofloxacine 500 mg once per day. This has an immunomodulating effect and keeps the virus at bay. Methylprednisolone at 1 mg per kg of body weight given three times per day is the corticosteroid used for 5 days, the gradually tapered to nothing over 16 days. The virus itself is treated with the antiviral drug ribavirin 400mg three times daily intravenously for three days or until the patient becomes stable, followed by tablets (1200mg twice per day) by mouth.

Outcome:

The good news with this protocol is that 70% of patients have left the hospital and are recovered; 27% are treated and are stable; three patients are mechanically ventilated (on a respirator), but stable. One patient who was an elderly diabetic patient has died of a heart attack.

There are no major side-effects of the treatment protocol. Some modifications are made with patients who have tuberculosis and with patients who are pregnant.

Here is an overview of SARS with links to the CDC.

Allergies, Asthma And Diabetes All Helped By Fish Oil

Cod liver oil was what your grandmother told you to take. It turns out she was right as two studies from Manchester/England and Boston/US have shown. The common denominator are omega-3-fatty acids, which are found in fish oil, cod liver oil, mackerel, salmon and other fish, generally speaking all sea food that feasts on plankton.

1. A prospective study with a cohort of 1100 children from before their birth until their 5th birthday, which will be next year, is being conducted in Manchester/England.

A smaller pilot study with 37 children (4-year-olds from this cohort) was recently analyzed as reported in Denver by Dr. Clare Murray, a pediatric lung specialist from the University of Manchester. The investigators have done detailed diet analyses with the help of the parents. They found that children with severe asthma were taking in a lot less omega-3-fatty acids than a healthy control group. Further analysis showed that the asthmatic group took in a lot of the inflammation provoking omega-6-fatty acids, whereas the control group had a much better balance between these two unsaturated fatty acids. Apparently it is the ratio between omega-6 to omega-3 fatty acids that determines whether the prostaglandin metabolism is switched versus pro-inflammatory (ratio more than 3 to 1) or versus anti-inflammatory (ratio 3 to1 or less). This article can be found in the Medical Post, Vol39, No.17 (page 19), April 29, 2003.

2. Another study is mentioned on the same page of the Medical Post: Dr. Frank Hu from the Harvard School of Public Health is the lead author of a study published in Circulation: Journal of the American Heart Association. 5103 female nurses with established type 2 diabetes have been followed for about 18 years and their medical histories, life styles and eating habits were updated every two years.

In the beginning of the study every patient was free of heart disease and cancer. The big surprise was that eating fish 5 times per week diminished the risk for developing heart disease by 65%. Even the women in the study who ate fish once or twice per week had 40% less heart disease than those who did not eat fish. In addition, fish eaters survived those who were not fish eaters much better (lower mortality). Controls of women without diabetes who ate fish five times per week had also a reduction of heart disease by 35% compared to non fish eating controls. Dr. Hu stated that it is the omega-3 fatty acids in fish that are the active ingredient. They are known to reduce irregular heart beats (arrhythmias) that can lead to sudden death. Omega-3 fatty acids also reduce blood fat levels (triglycerides), clot formation and improve blood vessel function. He also noted that both genders have the same benefit (no difference between male and female), just that the study was done on female nurses.

Comments: For your information the table below shows what foods contain omega-3 and omega-6 fatty acids.

In the past 50 years the food industry has changed the ratio of omega-6 to omega-3 fatty acids in many common foods to the point that the ratios are now 12 to 1 and up to 25 to 1. It is cheaper to produce these foods in that manner as they often have a longer shelve life. Read food labels. Inform yourself about omega-3 fatty acids. Take 2 capsules of fish oil once per day and include more fish in your meals. Avoid deep fried foods, as they contain omega-6 fatty acids.

Here are some links explaining this more:

Link about balanced nutrition.

More details about fat and fatty acids.